Induced hypernatremia in patients with moderate-to-severe ARDS: a randomized controlled study

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Nephrology

Background:

• Induced hypernatremia and hyperosmolarity demonstrate protective effects in animal models of lung injury.
• Moderate-to-severe acute respiratory distress syndrome (ARDS) presents a significant clinical challenge.
• Maintaining elevated plasma sodium levels is being investigated as a potential therapeutic strategy.

Purpose of the Study:

• To evaluate the safety and feasibility of inducing and maintaining moderate hypernatremia (plasma sodium 145–150 mmol/l) in patients with moderate-to-severe ARDS.
• To assess the impact of this intervention on lung injury and clinical outcomes.

Main Methods:

• A prospective randomized feasibility study was conducted.
• Patients with moderate-to-severe ARDS were assigned to either standard care or intravenous hypertonic saline (HTS) to achieve target plasma sodium levels for 7 days.
• Both groups received lung protective ventilation and conservative fluid management.

Main Results:

• Seventy-five percent of patients in the HTS group achieved the primary outcome (1-point reduction in lung injury score or successful extubation by day 7) compared to 35% in the control group (p=0.02).
• Patients receiving HTS had higher plasma sodium levels during the first 7 days (p=0.04).
• The HTS group showed a reduced length of mechanical ventilation and hospital stay.

Conclusions:

• Induced hypernatremia via hypertonic saline administration is a safe and feasible intervention for patients with moderate-to-severe ARDS.
• Clinical improvement was observed, supporting further investigation in a phase II study.
• This approach offers a promising strategy for managing ARDS.